How does the risk of cardiovascular death and cardiovascular risk factor profiles differ between socioeconomic classes in Poland: A country in transition
Abstract
Background: Socioeconomic status (SES) is an important factor for cardiovascular diseases (CVD) development. A decline in death rate from CVD among subjects with high SES is observed in developed countries. The aim of this study was to assess differences in cardiovascular risk (CV) between socioeconomic classes in Poland, a country currently in transition.
Methods: A sample of 15,200 people was drawn. A three stage selection was performed. Eventually, 6170 patients were examined (2013/2014). Data was collected using a questionnaire in face-to-face interviews, anthropometric data and blood tests were also obtained. Education was categorized as
incomplete secondary, secondary and higher than secondary school. Monthly income per person was categorized as low (≤ 1000 PLN), medium (1001–2000 PLN) and high (≥ 2001 PLN). Education and income groups were analyzed by prevalence of CVD risk factors and high CVD risk (SCORE ≥ 5%).
Results: Higher education was associated with lower prevalence of all analyzed CVD risk factors (p < 0.001), having the highest income with lower prevalence of hypertension, currently smoking, obesity and lower high density lipoprotein cholesterol. Multivariable analysis showed that frequency of high CVD risk decreased with increasing education level (OR 0.61; 95% CI 0.49–0.76; p < 0.01), a similar favorable impact of higher income on high CVD risk was demonstrated in the whole group (OR 0.81; 95% CI 0.67–0.99; p = 0.04).
Conclusions: Socioeconomic status is an independent predictor of high CV risk of death. A favorable impact on the prevalence of high CV risk was demonstrated for education and partly for income in the whole group. It may reflect a transition being undergone in Poland, moreover, it predicts how socioeconomic factors may generate health inequalities in other transitioning countries.
Keywords: socioeconomiceducationincomecardiovascular risk factorscardiovascular disease
References
- Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016; 37(29): 2315–2381.
- Perk J, De Backer G, Gohlke H, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2012; 33(13): 1635–1701.
- Mackenbach JP, Bos V, Andersen O, et al. Widening socioeconomic inequalities in mortality in six Western European countries. Int J Epidemiol. 2003; 32(5): 830–837.
- Wojtyniak B. Choroby układu krazenia jako priorytet zdrowia publicznego - Polska, Europa. In: Strzelecki Z, Szymborski J, editors. Zachorowalnosc i umieralnosc na choroby ukladu krazenia a sytuacja demograficzna Polski. Warszawa: Rzadowa Rada Ludnosciowa. ; 2015.
- Emberson JR, Whincup PH, Morris RW, et al. Social class differences in coronary heart disease in middle-aged British men: implications for prevention. Int J Epidemiol. 2004; 33(2): 289–296.
- Sommer I, Griebler U, Mahlknecht P, et al. Socioeconomic inequalities in non-communicable diseases and their risk factors: an overview of systematic reviews. BMC Public Health. 2015; 15: 914.
- Marmot MG, Smith GD, Stansfeld S, et al. Health inequalities among British civil servants: the Whitehall II study. Lancet. 1991; 337(8754): 1387–1393.
- Conroy RM, Pyörälä K, Fitzgerald AP, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003; 24(11): 987–1003.
- Zdrojewski T, Jankowski P, Bandosz P, et al. [A new version of cardiovascular risk assessment system and risk charts calibrated for Polish population]. Kardiol Pol. 2015; 73(10): 958–961.
- Drygas W, Niklas AA, Piwońska A, et al. Multi-centre National Population Health Examination Survey (WOBASZ II study): assumptions, methods, and implementation. Kardiol Pol. 2016; 74(7): 681–690.
- Kozakiewicz K, Podolecka E, Kwaśniewska M, et al. Association between socioeconomic status and cardiovascular risk. Kardiol Pol. 2016; 74(2): 179–184.
- Kozakiewicz K, Podolecka E, Syzdół M, et al. Relationship between education and cardiovascular risk score. Pol Arch Med Wewn. 2016; 126(5): 369–371.
- Eggen AE, Mathiesen EB, Wilsgaard T, et al. Trends in cardiovascular risk factors across levels of education in a general population: is the educational gap increasing? The Tromsø study 1994-2008. J Epidemiol Community Health. 2014; 68(8): 712–719.
- Méjean C, Droomers M, van der Schouw YT, et al. The contribution of diet and lifestyle to socioeconomic inequalities in cardiovascular morbidity and mortality. Int J Cardiol. 2013; 168(6): 5190–5195.
- Streel S, Donneau AF, Hoge A, et al. Socioeconomic Impact on the Prevalence of Cardiovascular Risk Factors in Wallonia, Belgium: A Population-Based Study. Biomed Res Int. 2015; 2015: 580849.
- Ren J, Guo XL, Lu ZL, et al. Ideal cardiovascular health status and its association with socioeconomic factors in Chinese adults in Shandong, China. BMC Public Health. 2016; 16: 942.
- Panagiotakos D, Georgousopoulou E, Notara V, et al. ATTICA Study Group. Education status determines 10-year (2002-2012) survival from cardiovascular disease in Athens metropolitan area: the ATTICA study, Greece. Health Soc Care Community. 2016; 24(3): 334–344.
- Janković S, Stojisavljević D, Janković J, et al. Association of socioeconomic status measured by education, and cardiovascular health: a population-based cross-sectional study. BMJ Open. 2014; 4(7): e005222.
- Di Chiara T, Scaglione A, Corrao S, et al. Association between low education and higher global cardiovascular risk. J Clin Hypertens (Greenwich). 2015; 17(5): 332–337.
- Stelmach W, Kaczmarczyk-Chałas K, Bielecki W, et al. How income and education contribute to risk factors for cardiovascular disease in the elderly in a former Communist country. Public Health. 2004; 118(6): 439–449.
- Bobak M, Marmot M. East-West mortality divide and its potential explanations: proposed research agenda. BMJ. 1996; 312(7028): 421–425.
- Bonaccio M, Di Castelnuovo A, Iacoviello L. Cardiovascular risk and events and country income stratum. N Engl J Med. 2015; 372(3): 288–289.
- Robert S, House JS. SES differentials in health by age and alternative indicators of SES. J Aging Health. 1996; 8(3): 359–388.
- Galea S, Tracy M. Participation rates in epidemiologic studies. Ann Epidemiol. 2007; 17(9): 643–653.
- Toor-Madry R, Bobak M, Pajak A. 5-year mortality in resondents and nonresondent for the cohort study of 20 000 randomly selected middle aged men and women. The HAPIEE Project. EuroPrevent 2012; Dublin: Euroean Journal of Preventive Cardiology; 2012. p. ; 71.
